Patient Information Form

Pharmacy medicines are sold at the professional discretion of our pharmacists. Please answer the following questions accurately to allow our pharmacy team to check that this product is suitable for the intended patient (s). All information provided will be treated confidentially and will only be available to the pharmacy staff processing your order. The pharmacy team may need to contact you by phone for additional information. Please ensure that the contact details you provide when you check out are correct. Please note, the pharmacy team reviewing this order only have access to the details on this form. They don’t have access to any other patient information that may have been provided either in store or online on previous occasions.

Don't forget to save your form to be able to add to cart

Is this medication for you?250 char. max

If No, please specify the name of the person250 char. max

What is the age of the person who will be using this product?250 char. max

What symptoms are going to be treated with this medication?250 char. max

How long have the symptoms been present?250 char. max

What action has been taken already for the symptoms described?250 char. max

Does the intended user have any other medical conditions?250 char. max

Description: Nurofen Day and Night Cold and Flu 200mg/5mg is a powerful combination of two effective ingredients Ibuprofen 200mg and Phenylephrine Hydrochloride 5mg. The tablets are easy to consume and works faster in relieving the pains, aches and dizziness caused due to colds and flu. The medicine is an effective cold and flu treatment safe for adults and children over 12 years of age.

Usage Directions:

Directly swallow the tablet with plain water

Do not chew

Maintain a minimum gap of 4 hours in every consecutive dose

Do not consume more than 6 tablets in a day

Side Effects and Precautions:

Do not exceed the stated dose

Keep the tablets away from the sight and reach of children, infants and pets

Strictly for short-term use only

Consult your doctor, if you are allergic to any of the ingredients used in the tablets

Seek medical help if you are pregnant, breast-feeding or planning to get pregnant

Do not combine the medication with any other cold and flu tablets

Do not consume if you have asthma, diabetes, high cholesterol or blood pressure or any kidney, liver or bowel related problem